| New Treatments for
Fractures of the Wrist
At Southend Hospital we have been
using bioabsorbable plates (figures six and seven) over the last
seven years. These plates offer the advantages of metal plates in
that they are strong enough to fix the fracture well enough to allow
immediate mobilization but unlike metal plates they are broken down
by the body after about three months and so will help to avoid the
problems with the tendons which occur with metal plates. These
plates are combined with bone substitutes. We have now published the
results of our use of bioabsorbable plates in a peer-reviewed
Journal, the Journal of Hand Surgery, and we have also published
other papers which demonstrate the technique in terms of the
approach to the wrist which we use.
Over the last four or five years it has become more
popular to approach the wrist from the volar surface, that is the
palmar surface of the wrist. The advantage of this approach is that
it avoids some of the problems associated with having a plate on the
back of the wrist. Since these angularly stable plates have been
available, this approach from the palmar side of the wrist has
become much more popular. Whilst this method offers advantages in
terms of the fact that there is less chance of tendons being
irritated due to the fact the plate is applied to the volar side of
the wrist, that is the palmar side where there are far fewer
tendons, because the screws which are used have to come through to
the dorsal or top side of the wrist there is still the potential for
irritation of tendons. For patients where there is involvement of
the joint surfaces it is sometimes difficult to see and reduce (that
is put back into place) the joint surfaces from the volar side which
limits the use of this approach.
There are now also special plates
which can be applied to the specific parts of the wrist which are
broken, what is called a column approach. This means that smaller
plates may be applied to specific fragments within the wrist and
these can be very useful for particular fracture patterns. |
